MICHAEL ISAAC ELLENBOGEN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059268

License Status

CANCELLED

Business

Title

First Name

MICHAEL

Middle

ISAAC

Last Name

ELLENBOGEN

Business Name

MICHAEL ISAAC ELLENBOGEN MD

Original Issue Date

06/23/2011

Effective Date

06/23/2011

Expiration Date

06/22/2014

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/12/2011